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GP practices given green light to close lists unilaterally in ‘urgent’ circumstances



Exclusive GP practices can legitimately take steps to ‘temporarily halt’ taking on new patients on an informal basis, if they face short-term problems providing adequate cover, according to advice issued to LMCs.

The NHS England statement, disseminated to LMCs by the GPC, supports GPC guidance on how practices should deal with list closures and comes after one GP was threatened with a breach-of-contract notice after taking steps to close his practice’s list informally, in line with the GPC advice.

However, the new guidance said that practices may take the ‘urgent action’ to stop registering new patients temporarily if they feel they need to – provided they then ask for help from the area team to sort the problem out.

It follows correspondence between NHS England and the GPC after Dr Hadrian Moss, a GP in Kettering, Northamptonshire, was contacted by the Central Midlands local area team to say he was in breach of his contract.

This followed a blog he wrote for Pulse explaining how he had decided to follow GPC advice to close his practice list informally.

Dr Moss said he took the step because the practice was struggling to cope, with GPs having to put in regular 10-hour days to make up for the loss of a partner who retired early this year and has yet to be replaced.

The row led to a question in the House of Commons, with health minister Daniel Poulter promising to ‘look into the matter’.

The new advice, revealed by GPC, says that practices would only need to make a formal application to close their list if ‘progress was not being made’.

The NHS England statement reads: ‘Because of our need to ensure we engage with the local community regarding the services we commission, we do not accept that a practice can close its list without going through a formal process of engagement.

‘However, we do appreciate that there are times when urgent action needs to be taken. If there is a sudden impact on a practice’s ability to provide patient services, we accept that a temporary halt to new patient registration is appropriate, but this should be followed quickly by a discussion with the commissioner to identify an action plan to address the issues. Where it is evident that the issues can be resolved within a short time scale, then we would look to support a practice address these issues without requiring formal list closure.’

It adds: ‘If progress was not being made, we would advise that consideration be given formally to close the list. Where a practice is opting to restrict patient registration without discussing the implications and appropriate actions with NHS England, we would consider whether contractual action ought to be taken.’

Dr Richard Vautrey, deputy chair of the GPC, told Pulse the statement reaffirmed the GPC’s advice and that NHS England was now taking a more supportive position.

He said: ‘What they have said has underlined the position we took. These incidences are a cry for help as much as anything. A practice needs the support of the area team and it would appear it is now starting to get that, which is a good thing.’

Pulse understands talks between Dr Moss and NHS England Midlands and East (Central Midlands) area team are continuing.

A spokesperson for the area team said: ‘We can confirm that a meeting has taken place with the practice, discussions are ongoing and there are no further updates as yet.’

An NHS England spokesperson said: ‘NHS England’s position on this issue has not changed. We have a responsibility to ensure that services are available to patients. We continue to work with the GPC on this important issue.’